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Doctor and Patient: Cultural Considerations & Cultivating Shared Decision Marking

Cultural Considerations: Cultivating Shared Decision-Making Between Patients and Healthcare Professionals

April 11, 2024 | Rheumatic Disease


Culture has been defined as encompassing "group membership," including "racial, ethnic, linguistic, or geographical groups, along with a collection of beliefs, values, customs, and ways of thinking, communicating, and behaving (CDC, 2022).” Studies have demonstrated that patient preferences for comprehensive, holistic, medication-based, and non-medication treatments for rheumatoid arthritis vary based on racial and ethnic backgrounds. This underscores the significance of considering patient preferences and cultural factors in the shared decision-making process between healthcare professionals and patients.

Decision-making in rheumatology is intricate and often fails to consider cultural factors. At the same time, letting patients drive these decisions can be just as complicated since they're influenced by many different things (Loyola‐Sanchez et al., 2020). By having doctors and patients make decisions together through shared decision-making, there is an opportunity to provide care that's more culturally sensitive.

By having a healthcare workforce with "cultural intelligence" – the ability to relate and work effectively with people from diverse cultural backgrounds – it can enhance care for rheumatic disease patients ("About Cultural Intelligence," 2018). However, building true partnerships where mutual decisions can be made requires understanding each other's values and biases (Kon, 2010).

To foster environments conducive to trusting relationships with patients, rheumatology healthcare professionals can take several steps to facilitate successful shared decision-making:

Step 1: Self-analysis – Reflect on personal biases and reactions to become aware of areas for improvement. There is always room for growth!

Step 2: Vulnerability – It is acceptable not to have all the answers, but it is essential to be open to learning about others, their cultures, and preferences.

Step 3: Courageously inquire – "What cultural considerations might impact your care, and would you be willing to share them with me?" Embrace a stance of cultural humility, recognizing that there is always more to learn.

In conclusion, valuing and integrating patient’s cultural preferences into shared decision-making processes in rheumatology can lead to more personalized and culturally sensitive care for patients with rheumatic diseases. By acknowledging biases, fostering vulnerability, and actively seeking to understand cultural considerations, clinicians can establish trusting relationships with their patients and collaboratively navigate treatment decisions. Embracing cultural humility and ongoing self-reflection are vital for delivering equitable and patient-centered care in diverse healthcare settings.

Lisa Carnago, FNP-C, MSN, BSN, RN

About the Author

Lisa Carnago, FNP-C, MSN, BSN, RN

Lisa Carnago, FNP-C, MSN, BSN, RN, is a family nurse practitioner who works for Duke Health in the Division of Rheumatology and Immunology. She specializes in opioid use in chronic pain settings, team-based models of care, and uveitis, an autoimmune inflammatory eye disease. Currently, she is also working on a PhD in nursing at Duke University. Lisa is a member of the American College of Rheumatology’s Communications and Marketing Committee.

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